OBS: Antenatal Care -- Rhesus D Screening

Question 1

Speific questions to ask if Rhesus D is -ve

Answer 1

Sensitization events (previous pregnancy, miscarriage, APH, invasive diagnostic procedures, abdominal injury)
Rhesus status of baby in previous pregnancy
Any anti-D Ig received in previous pregnancy
Any history of haemolytic disease of newborn in previous pregnancy

Question 2

Management of non-immunized pregnancies

Answer 2

1. Anti-D Ig
   
   1. [at 28w] after antibody screening -ve
   2. immediately after any potential sensitizing events

Question 3

Management of RhD+ baby in isoimmunised mother

Answer 3

1. Careful Hx taking to determine the cause of isoimmunization
2. Close monitoring with USG for any signs of fetal anaemia
   
   1. MCA PSV
   2. features of hydrops fetalis
3. if severe or progressing fetal anaemia Intra-uterine blood transfusion Q3~4w
4. if IU transfusion fails Consider early delivery >34w

Question 4

Causes of fetal anaemia

Answer 4

Thalassaemia major
Hemolytic disease of newborn
TTTS donor
Parvovirus infection in mother